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1.
Pediatr Cardiol ; 42(6): 1405-1409, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34258648

RESUMO

The objective of this study was to explore a new method for the differential diagnosis between fetal double aortic arch (DAA) and right aortic arch with mirror-image branches (RAA-MB). Clinical data and prenatal echocardiographic features of the DAA (n = 22) and RAA-MB (n = 65) confirmed by postnatal or autopsy findings were analyzed retrospectively. The angles between the two aortic arches in the DAA group and between the right aortic arch and the mirror branch were measured. The differences between the two groups and differential diagnosis value of the angles were compared and analyzed based on the receiver operating characteristic curve. The proportion of left-sided ductal arteriosus (100%) was higher in the DAA group than that (32.3%) in the RAA-MB group, (P < 0.05). The proportion of conotruncal anomalies is higher in the RAA-MB group (64.6%) than in the DAA group (18.2%) (P < 0.05). There was a significant difference in the angles between the groups (DAA: 50.3° ± 8.3° vs. RAA-MB: 82.9° ± 13.8°) (P < 0.01). When the cutoff value was 62.8°, the sensitivity and specificity of the differential diagnosis were 95.5% and 96.9%, respectively. Distinguishing the angle measurement between DAA and RAA-MB is helpful in prenatal prognosis. We recommend a cutoff value of 62.8°.


Assuntos
Aorta Torácica/diagnóstico por imagem , Síndromes do Arco Aórtico/diagnóstico , Canal Arterial/diagnóstico por imagem , Ecocardiografia/métodos , Ultrassonografia Pré-Natal/métodos , Anel Vascular/diagnóstico , Adulto , Aorta Torácica/anormalidades , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Gravidez , Estudos Retrospectivos , Adulto Jovem
2.
Pan Afr Med J ; 39: 9, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34178237

RESUMO

We conducted a study of five patients with congenital diaphragmatic hernia (CDH) in the department of antenatal diagnosis over a period of two years. Our study highlights the overall benchmarks for this disease and its management as well as the news on prenatal assessment of neonatal prognosis using Lung Over Head Ratio (LHR): ultrasound versus magnetic resonance imaging (MRI) in the third world. The purpose of this study is to evaluate the prognosis of these new-born babies and support parents of a fetus with diaphragmatic hernia.


Assuntos
Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Ultrassonografia Pré-Natal/métodos , Adulto , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Diagnóstico Pré-Natal , Prognóstico , Estudos Prospectivos , Adulto Jovem
3.
Acta Orthop Traumatol Turc ; 55(3): 196-200, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34100358

RESUMO

OBJECTIVE: This study aimed to determine the predictability of developmental dysplasia of the hip (DDH) in the prenatal period by means of evaluating fetal hips using the Graf method on obstetric ultrasonography (US) after the 34th week of gestation. METHODS: A total of 84 pregnant women (mean age = 27.04; age range = 19-46 years), who were referred to our radiology clinic for an obstetric US examination in the third trimester, and their fetuses were included in this study. In the obstetric US, alpha angles of both hips of the fetuses were measured based on Graf's method, and each case was assessed ultrasonographically by a second physician at 6-10 postnatal weeks. Prenatal and postnatal hips were then classified according to alpha angles as ≥ 60° or < 60°. The kappa coefficients between the diagnoses based on prenatal and postnatal alpha angles were calculated. RESULTS: According to the postnatal alpha angle, 77 fetuses were diagnosed to have type 1 right hip and 7 fetuses had type 2A right hip. The prenatal alpha angle provided the same results (77 type 1 and 7 type 2A right hips). Similarly, the postnatal alpha angle revealed type 1 left hip in 82 fetuses and type 2A left hip in 2 fetuses, which was the same as the diagnoses based on the prenatal alpha angles. There was a complete agreement between prenatal and postnatal alpha measurements for both the left and right hips (kappa = 1.00, P < 0.001). CONCLUSION: Evidence from this study has revealed that DDH can be identified by obstetric ultrasonographic examinations in the prenatal period.


Assuntos
Displasia do Desenvolvimento do Quadril/diagnóstico , Feto/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Adulto , Feminino , Seguimentos , Luxação Congênita de Quadril/diagnóstico , Luxação Congênita de Quadril/etiologia , Articulação do Quadril/diagnóstico por imagem , Humanos , Recém-Nascido , Valor Preditivo dos Testes , Gravidez , Terceiro Trimestre da Gravidez
4.
Pediatr Cardiol ; 42(6): 1416-1424, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33963894

RESUMO

Vein of Galen aneurysmal malformation (VGAM) is a rare anomaly associated with poor outcomes from high output cardiac failure and neurologic complications. Studies addressing fetal cardiovascular status and outcomes in this population are limited. A single-center retrospective review was conducted on patients with a prenatal diagnosis of VGAM who underwent a fetal echocardiogram between January 2015 and July 2019. Fetal echocardiographic data, brain magnetic resonance imaging (MRI) findings and outcomes were collected. Nine fetuses [median gestational age at echocardiogram 34 (1.1) weeks] were included. All patients had superior vena cava dilation and reversal of diastolic flow in the transverse aortic arch. Median cardiothoracic (CT) ratio was 0.39 (0.09). Right ventricular (RV) and left ventricular (LV) dysfunction was present in 66% and 11% fetuses, respectively. Four out of five patients that underwent postnatal endovascular neurosurgical interventions at our center were alive at follow-up (mean 2.7 years). Of the non-survivors (n = 5), 3 received comfort care because of severe brain damage and died in the neonatal period. Non-survivors more commonly had > mild tricuspid regurgitation (TR) (40% vs. 25%) and > mild RV dilation (60% vs. 25%). Combined cardiac index (CCI) was higher in non-survivors when compared to survivors (672.7 vs. 530.2 ml/kg/min, p = 0.016). Fetuses with significant parenchymal damage on brain MRI tended to have a higher CCI than those without (979.8 vs. 605.0 ml/kg/min, p = 0.047). RV dysfunction, TR and elevated CCI are more commonly seen in non-survivors with VGAM. A higher CCI is seen in those deemed untreatable due to significant parenchymal volume loss. Future multicenter studies are needed to assess for prenatal prediction of outcomes in this high-risk population.


Assuntos
Ecocardiografia/métodos , Imagem Cinética por Ressonância Magnética/métodos , Ultrassonografia Pré-Natal/métodos , Malformações da Veia de Galeno/fisiopatologia , Veia Cava Superior/fisiopatologia , Feminino , Idade Gestacional , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Recém-Nascido , Masculino , Gravidez , Estudos Retrospectivos , Malformações da Veia de Galeno/diagnóstico , Veia Cava Superior/anormalidades , Veia Cava Superior/diagnóstico por imagem
5.
Nat Med ; 27(5): 882-891, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33990806

RESUMO

Congenital heart disease (CHD) is the most common birth defect. Fetal screening ultrasound provides five views of the heart that together can detect 90% of complex CHD, but in practice, sensitivity is as low as 30%. Here, using 107,823 images from 1,326 retrospective echocardiograms and screening ultrasounds from 18- to 24-week fetuses, we trained an ensemble of neural networks to identify recommended cardiac views and distinguish between normal hearts and complex CHD. We also used segmentation models to calculate standard fetal cardiothoracic measurements. In an internal test set of 4,108 fetal surveys (0.9% CHD, >4.4 million images), the model achieved an area under the curve (AUC) of 0.99, 95% sensitivity (95% confidence interval (CI), 84-99%), 96% specificity (95% CI, 95-97%) and 100% negative predictive value in distinguishing normal from abnormal hearts. Model sensitivity was comparable to that of clinicians and remained robust on outside-hospital and lower-quality images. The model's decisions were based on clinically relevant features. Cardiac measurements correlated with reported measures for normal and abnormal hearts. Applied to guideline-recommended imaging, ensemble learning models could significantly improve detection of fetal CHD, a critical and global diagnostic challenge.


Assuntos
Ecocardiografia Tridimensional/métodos , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/patologia , Diagnóstico Pré-Natal/métodos , Ultrassonografia Pré-Natal/métodos , Adulto , Biometria , Feminino , Feto/anormalidades , Feto/diagnóstico por imagem , Coração/diagnóstico por imagem , Humanos , Programas de Rastreamento/métodos , Miocárdio/patologia , Redes Neurais de Computação , Gravidez , Segundo Trimestre da Gravidez , Sensibilidade e Especificidade , Tórax/diagnóstico por imagem , Adulto Jovem
6.
BMC Pregnancy Childbirth ; 21(1): 343, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33931016

RESUMO

BACKGROUND: Different formulae have been developed globally to estimate gestational age (GA) by ultrasonography in the first trimester of pregnancy. In this study, we develop an Indian population-specific dating formula and compare its performance with published formulae. Finally, we evaluate the implications of the choice of dating method on preterm birth (PTB) rate. This study's data was from GARBH-Ini, an ongoing pregnancy cohort of North Indian women to study PTB. METHODS: Comparisons between ultrasonography-Hadlock and last menstrual period (LMP) based dating methods were made by studying the distribution of their differences by Bland-Altman analysis. Using data-driven approaches, we removed data outliers more efficiently than by applying clinical parameters. We applied advanced machine learning algorithms to identify relevant features for GA estimation and developed an Indian population-specific formula (Garbhini-GA1) for the first trimester. PTB rates of Garbhini-GA1 and other formulae were compared by estimating sensitivity and accuracy. RESULTS: Performance of Garbhini-GA1 formula, a non-linear function of crown-rump length (CRL), was equivalent to published formulae for estimation of first trimester GA (LoA, - 0.46,0.96 weeks). We found that CRL was the most crucial parameter in estimating GA and no other clinical or socioeconomic covariates contributed to GA estimation. The estimated PTB rate across all the formulae including LMP ranged 11.27-16.50% with Garbhini-GA1 estimating the least rate with highest sensitivity and accuracy. While the LMP-based method overestimated GA by 3 days compared to USG-Hadlock formula; at an individual level, these methods had less than 50% agreement in the classification of PTB. CONCLUSIONS: An accurate estimation of GA is crucial for the management of PTB. Garbhini-GA1, the first such formula developed in an Indian setting, estimates PTB rates with higher accuracy, especially when compared to commonly used Hadlock formula. Our results reinforce the need to develop population-specific gestational age formulae.


Assuntos
Estatura Cabeça-Cóccix , Idade Gestacional , Primeiro Trimestre da Gravidez , Nascimento Prematuro/classificação , Ultrassonografia Pré-Natal/métodos , Adulto , Feminino , Humanos , Índia , Recém-Nascido , Gravidez , Estudos Prospectivos , Adulto Jovem
7.
BMC Pregnancy Childbirth ; 21(1): 365, 2021 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-33964891

RESUMO

BACKGROUND: Accurate estimation of fetal weight is important for prenatal care and for detection of fetal growth abnormalities. Prediction of fetal weight entails the indirect measurement of fetal biometry by ultrasound that is then introduced into formulae to calculate the estimated fetal weight. The aim of our study was to evaluate the accuracy of fetal weight estimation of Chinese fetuses in the third trimester using an automated three-dimensional (3D) fractional limb volume model, and to compare this model with the traditional two-dimensional (2D) model. METHODS: Prospective 2D and 3D ultrasonography were performed among women with singleton pregnancies 7 days before delivery to obtain 2D data, including fetal biparietal diameter, abdominal circumference and femur length, as well as 3D data, including the fractional arm volume (AVol) and fractional thigh volume (TVol). The fetal weight was estimated using the 2D model and the 3D fractional limb volume model respectively. Percentage error was defined as (estimated fetal weight - actual birth weight) divided by actual birth weight and multiplied by 100. Systematic errors (accuracy) were evaluated as the mean percentage error (MPE). Random errors (precision) were calculated as ±1 SD of percentage error. The intraclass correlation coefficient (ICC) was used to analyze the inter-observer reliability of the 3D ultrasound measurements of fractional limb volume. RESULTS: Ultrasound examination was performed on 56 fetuses at 39.6 ± 1.4 weeks' gestation. The average birth weight of the newborns was 3393 ± 530 g. The average fetal weight estimated by the 2D model was 3478 ± 467 g, and the MPE was 3.2 ± 8.9. The average fetal weights estimated by AVol and TVol of the 3D model were 3268 ± 467 g and 3250 ± 485 g, respectively, and the MPEs were - 3.3 ± 6.6 and - 3.9 ± 6.1, respectively. For the 3D TVol model, the proportion of fetuses with estimated error ≤ 5% was significantly higher than that of the 2D model (55.4% vs. 33.9%, p < 0.05). For fetuses with a birth weight < 3500 g, the accuracy of the AVol and TVol models were better than the 2D model (- 0.8 vs. 7.0 and - 2.8 vs. 7.0, both p < 0.05). Moreover, for these fetuses, the proportions of estimated error ≤ 5% of the AVol and TVol models were 58.1 and 64.5%, respectively, significantly higher than that of the 2D model (19.4%) (both p < 0.05). The inter-observer reliability of measuring fetal AVol and TVol were high, with the ICCs of 0.921 and 0.963, respectively. CONCLUSION: In this cohort, the automated 3D fractional limb volume model improves the accuracy of weight estimation in most third-trimester fetuses. Prediction accuracy of the 3D model for neonatal BW, particularly < 3500 g was higher than that of the traditional 2D model.


Assuntos
Peso Fetal , Feto/diagnóstico por imagem , Imageamento Tridimensional , Coxa da Perna/anatomia & histologia , Ultrassonografia Pré-Natal/métodos , Adulto , Estudos Transversais , Feminino , Humanos , Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Software , Coxa da Perna/diagnóstico por imagem
8.
Pediatr Cardiol ; 42(6): 1365-1371, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33903942

RESUMO

Prenatal prediction of coarctation of the aorta (CoA) is challenging. Methods identifying prenatal CoA have high sensitivity with significant false positives. We previously derived prenatal aortic arch angles for identifying CoA with high sensitivity and specificity and aim to validate these angles and compare them with a model utilizing ascending aorta (AAo) and isthmus (Aoi) measures. Retrospective case/cohort study of fetuses with prenatal suspicion for CoA. 35 fetuses were included. Measurements included: ascending-descending aortic angle (AAo.DAo), transverse-descending aortic angle (TAo.DAo); diameters and z-scores of Aoi from sagittal (Aoi-sag), three-vessel (Aoi-3VV) view and AAo. Discriminant functions for the 5 variables were compared using histograms and positive/negative predictive values (PPV/NPV). CoA was confirmed in 28/35 neonates. The PPV and NPV for angle measures were 100% and 77%. The AAo + Aoi-3VV model PPV and NPV were 92% and 80% and Aoi-sag + Aoi-3VV model were 82% and 71%. A linear discriminant model utilizing the 3 most predictive variables improved NPV to 90% and PPV to 100%. In conclusion, we validate that angle measures are superior to standard models of predicting CoA. An optimized 3 variable model maintains accuracy of identifying CoA while eliminating false positives.


Assuntos
Aorta Torácica/diagnóstico por imagem , Coartação Aórtica/diagnóstico , Ecocardiografia/métodos , Feto/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Valor Preditivo dos Testes , Gravidez , Estudos Retrospectivos
10.
Gynecol Obstet Invest ; 86(1-2): 200-208, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33902041

RESUMO

OBJECTIVES: The duration of the latent period is uncertain in preterm premature rupture of membranes (PPROM). This time estimate provides information on the time of the corticosteroid to be applied and the time of delivery of the pregnant women. Here, we used transvaginal sonography to determine the relationship between the uterocervical angle (UCA) and PPROM latency and the risk for neonatal complications. DESIGN: This is a prospective cohort study of 80 singleton pregnancies with PPROM. Participants/Materials, Setting, and Methods: This prospective cohort study was conducted at a tertiary center with a total of 80 singleton pregnancies with PPROM. The UCA and cervical length were measured in the first evaluation of PPROM in patients between 24 and 34 weeks of age. The study population was subdivided into 2 groups: group 1 (n = 27) included women who gave birth within 10 days after a PPROM diagnosis and group 2 (n = 53) included women who gave birth later than this. Our aim was latency prediction (more or less than 10 days) in PPROM patients undergoing regular UCA monitoring. RESULTS: Of the women in group 1, 74.1% (n = 20) had spontaneous births and 7.4% (n = 2) had induced births because of clinical chorioamnionitis. Of the women in group 2, 71.6% (n = 38) had spontaneous births and 7.6% (n = 4) had induced births because of clinical chorioamnionitis (n = 3) or poor fetal condition (n = 1). We drew receiver operating characteristic curves to explore whether the UCA predicted birth within 10 days of PPROM. The area under the curve was 0.894 (p < 0.001). The optimal UCA cutoff was 108°, with 93% sensitivity and 85% specificity. LIMITATIONS: First, the sample size was small; it would have been better to have more patients. Second, we measured the UCA only once. Third, patients were not categorized by parity. CONCLUSIONS: The UCA, measured by the transvaginal route, can successfully predict latent period in PPROM. Measuring the UCA can be useful to determine the time of corticosteroid administration and to inform patients about the time of birth.


Assuntos
Colo do Útero/diagnóstico por imagem , Ruptura Prematura de Membranas Fetais/diagnóstico , Ultrassonografia Pré-Natal/métodos , Útero/diagnóstico por imagem , Corticosteroides/administração & dosagem , Adulto , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/diagnóstico por imagem , Estudos Prospectivos , Curva ROC , Fatores de Tempo
11.
BMC Pregnancy Childbirth ; 21(1): 324, 2021 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-33894762

RESUMO

BACKGROUND: To establish reference ranges of fetal facial profile markers and study their correlations with crown-rump length (CRL) during the first trimester (11 ~ 13+ 6 weeks' gestation) in a Chinese population. METHODS: Ultrasonographic images of measuring fetal nuchal translucency (NT) were retrospectively selected randomly in normal fetuses whose parents were both Chinese. The facial markers included inferior facial angle (IFA), maxilla-nasion-mandible (MNM) angle, facial maxillary angle (FMA) and profile line (PL) distance. These markers were measured through ViewPoint 6 software by two experienced sonographers. RESULTS: Three hundred and eighty fetuses were selected. The ICCs (95 % CI) of intra-operator 1 reproducibility of IFA, MNM angle, FMA, PL distance were 0.944 (0.886 ~ 0.973), 0.804 (0.629 ~ 0.902), 0.834 (0.68 ~ 0.918) and 0.935 (0.868 ~ 0.969), respectively. The ICCs (95 % CI) of intra-operator 2 reproducibility of IFA, MNM angle, FMA, PL distance were 0.931 (0.857 ~ 0.967), 0.809 (0.637 ~ 0.904), 0.786 (0.600 ~ 0.892) and 0.906 (0.813 ~ 0.954), respectively. The ICCs (95 % CI) of inter-operator reproducibility of IFA, MNM angle, FMA, PL distance were 0.885 (0.663 ~ 0.953), 0.829 (0.672 ~ 0.915), 0.77 (0.511 ~ 0.891) and 0.844 (0.68 ~ 0.925), respectively. The average ± SD of IFA, MNM angle, FMA and PL distance were 80.2°±7.25°, 4.17°±1.19°, 75.36°±5.31°, 2.78 ± 0.54 mm, respectively. IFA and PL distance significantly decreased with CRL, while MNM angle and FMA significantly increased with CRL. CONCLUSIONS: It was feasible to measure fetal facial markers during the first trimester. In Chinese population, the reference ranges of IFA, MNM angle, FMA and PL distance were 80.2°±7.25°, 4.17°±1.19°, 75.36°±5.31°, 2.78 ± 0.54 mm, respectively, and the measurements were found to correlate with CRL.


Assuntos
Estatura Cabeça-Cóccix , Face , Feto/diagnóstico por imagem , Medição da Translucência Nucal/métodos , Ultrassonografia Pré-Natal/métodos , Adulto , China/epidemiologia , Precisão da Medição Dimensional , Face/anormalidades , Face/diagnóstico por imagem , Estudos de Viabilidade , Feminino , Idade Gestacional , Humanos , Gravidez , Primeiro Trimestre da Gravidez , Reprodutibilidade dos Testes
12.
BMC Pregnancy Childbirth ; 21(1): 328, 2021 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-33902496

RESUMO

BACKGROUND: Ninety-four percent of all maternal deaths occur in low- and middle-income countries, and the majority are preventable. Access to quality Obstetric ultrasound can identify some complications leading to maternal and neonatal/perinatal mortality or morbidity and may allow timely referral to higher-resource centers. However, there are significant global inequalities in access to imaging and many challenges to deploying ultrasound to rural areas. In this study, we tested a novel, innovative Obstetric telediagnostic ultrasound system in which the imaging acquisitions are obtained by an operator without prior ultrasound experience using simple scan protocols based only on external body landmarks and uploaded using low-bandwidth internet for asynchronous remote interpretation by an off-site specialist. METHODS: This is a single-center pilot study. A nurse and care technician underwent 8 h of training on the telediagnostic system. Subsequently, 126 patients (68 second trimester and 58 third trimester) were recruited at a health center in Lima, Peru and scanned by these ultrasound-naïve operators. The imaging acquisitions were uploaded by the telemedicine platform and interpreted remotely in the United States. Comparison of telediagnostic imaging was made to a concurrently performed standard of care ultrasound obtained and interpreted by an experienced attending radiologist. Cohen's Kappa was used to test agreement between categorical variables. Intraclass correlation and Bland-Altman plots were used to test agreement between continuous variables. RESULTS: Obstetric ultrasound telediagnosis showed excellent agreement with standard of care ultrasound allowing the identification of number of fetuses (100% agreement), fetal presentation (95.8% agreement, κ =0.78 (p < 0.0001)), placental location (85.6% agreement, κ =0.74 (p < 0.0001)), and assessment of normal/abnormal amniotic fluid volume (99.2% agreement) with sensitivity and specificity > 95% for all variables. Intraclass correlation was good or excellent for all fetal biometric measurements (0.81-0.95). The majority (88.5%) of second trimester ultrasound exam biometry measurements produced dating within 14 days of standard of care ultrasound. CONCLUSION: This Obstetric ultrasound telediagnostic system is a promising means to increase access to diagnostic Obstetric ultrasound in low-resource settings. The telediagnostic system demonstrated excellent agreement with standard of care ultrasound. Fetal biometric measurements were acceptable for use in the detection of gross discrepancies in fetal size requiring further follow up.


Assuntos
Assistência Perinatal , Consulta Remota/métodos , Desenvolvimento de Pessoal , Telemedicina/métodos , Ultrassonografia Pré-Natal , Diagnóstico Precoce , Intervenção Médica Precoce/normas , Feminino , Humanos , Obstetrícia/educação , Assistência Perinatal/métodos , Assistência Perinatal/normas , Peru/epidemiologia , Testes Imediatos/organização & administração , Gravidez , Trimestres da Gravidez , Melhoria de Qualidade/organização & administração , Serviços de Saúde Rural/normas , Serviços de Saúde Rural/tendências , Enfermagem Rural/métodos , Desenvolvimento de Pessoal/métodos , Desenvolvimento de Pessoal/organização & administração , Ultrassonografia Pré-Natal/métodos , Ultrassonografia Pré-Natal/normas
13.
Am J Perinatol ; 38(7): 747-752, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33853148

RESUMO

OBJECTIVE: A majority of studies evaluating the risk of vertical transmission and adverse outcomes in pregnancies with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are mostly based on third-trimester infections. There is limited data available on pregnancy sequelae of maternal infection in the first or second trimester. STUDY DESIGN: We present a patient with monochorionic-diamniotic twins that develops coronavirus disease 2019 infection at 15 weeks of gestation. The pregnancy is further complicated by stage II twin-twin transfusion syndrome. She undergoes laser ablation, which is complicated by development of a subchorionic hematoma. The patient then develops Escherichia coli bacteremia, resulting in septic shock and preterm labor followed by previable delivery at 21 weeks of gestation. Amniotic fluid and placenta were negative for SARS-CoV-2 by real-time polymerase chain reaction. CONCLUSION: This case of SARS-CoV-2 argues against transplacental transmission after a second-trimester infection but brings attention to the possible downstream complications that may arise following early infection. KEY POINTS: · Vertical transmission of SARS-CoV-2 is not evident after a second-trimester infection.. · Antepartum coronavirus disease 2019 may cause vascular placental changes and placental insufficiency.. · SARS-CoV-2 is associated with a maternal hypercoagulable state with adverse perinatal outcomes..


Assuntos
COVID-19 , Infecções por Escherichia coli , Transfusão Feto-Fetal , Placenta , Complicações Infecciosas na Gravidez , Segundo Trimestre da Gravidez , Choque Séptico , Adulto , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/fisiopatologia , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/diagnóstico , Feminino , Transfusão Feto-Fetal/diagnóstico , Transfusão Feto-Fetal/etiologia , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Placenta/diagnóstico por imagem , Placenta/fisiopatologia , Gravidez , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez , Gravidez de Gêmeos , Nascimento Prematuro/etiologia , Nascimento Prematuro/virologia , SARS-CoV-2 , Choque Séptico/diagnóstico , Choque Séptico/etiologia , Gêmeos Monozigóticos , Ultrassonografia Pré-Natal/métodos
14.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 48(1): 36-40, ene.-mar. 2021. ilus
Artigo em Espanhol | IBECS | ID: ibc-201989

RESUMO

La pentalogía de Cantrell, o también llamada hernia diafragmática peritoneo-pericárdica, es un síndrome raro que engloba cinco defectos básicos de corazón, esternón, pared abdominal supraumbilical, diafragma y pericardio, cuya incidencia es de aproximadamente uno por cada 200.000 nacimientos1 con un predominio masculino con una relación de 1,35:12. Los doctores Cantrell, Haller y Ravitch describieron esta patología en 19581, recientemente se propuso una hexalogía adicionando al diagnóstico la presencia de una arteria umbilical única3. Se describe el caso de una paciente de 20 años, cursando un embarazo de 26,3 semanas cuyo feto desarrolló una pentalogía de Cantrell asociada a transposición de los grandes vasos. OBJETIVO: El presente artículo pretende describir un caso de pentalogía de Cantrell con una revisión de su fisiopatología, datos diagnósticos, clasificación y manejo. MÉTODOS/ESTRATEGIA DE BÚSQUEDA: Revisión de la historia clínica de la paciente dentro del Servicio de Ginecología y Obstetricia del Hospital San Vicente de Paúl en Ibarra, Ecuador. RESULTADOS: Ecografía obstétrica reporta feto de 26 semanas de gestación, evidenciándose defecto de pared torácica de 2,84 cm al corte axial, que provoca ectopia cardíaca completa, defecto de pared abdominal superior de 4,3 cm al corte transversal que produce protrusión de parénquima hepático, a la ecocardiografía se evidencia transposición de los grandes vasos, se cataloga como pentalogía de Cantrell tipo I. Se decide terminación de embarazo por incompatibilidad con la vida, obteniéndose recién nacido masculino, en el que se comprobó los defectos torácico y abdominal, fallece a los pocos minutos. IMPLICACIONES PARA LA PRÁCTICA: Resaltar la importancia de la ecografía estructural o morfológica, entre las 18 a 24 semanas, para detectar malformaciones congénitas mayores, obtener un diagnóstico certero y realizar un manejo oportuno. IMPLICACIONES PARA LA INVESTIGACIÓN: Se requieren más estudios para determinar etiología y manejo para estos pacientes, ya que se reportan casos de sobrevivencia de los mismos


Cantrell's Pentalogy, and also called peritoneum-pericardial diaphragmatic hernia, is a rare syndrome that includes five basic defects of the heart, sternum, supra-umbilical abdominal wall, diaphragm, and pericardium. Its incidence is approximately 1 for every 200,000 births, with a male predominance with a ratio of 1.35: 1. Doctors Cantrell, Haller and Ravitch described this pathology in 1958 and recently a hexalogy was proposed, adding the presence of a single umbilical artery to the diagnosis. The case is presented on a 20-year-old woman in a 26.3 weeks pregnancy in whom the foetus developed Cantrell's Pentalogy associated with transposition of the great vessels. PURPOSE: This article aims to describe a case of Cantrell's Pentalogy with a review of its physiopathology, diagnostic data, classification, and management. METHODS/SEARCH STRATEGY: Review of the patient's clinical history in the gynaecology and obstetrics service of the San Vicente de Paul Hospital in Ibarra - Ecuador. RESULTS: Obstetric ultrasound showed a foetus of 26 weeks of gestation, with a chest wall defect of 2.84 cm at the axial section that caused complete cardiac ectopy, as well as an upper abdominal wall defect of 4.3cm at the cross section that produced a protrusion of the liver parenchyma. In the cardiac ultrasound transposition of the great vessels could be seen, and was classified as Cantrell's Pentalogy type I. Termination of pregnancy was decided due to incompatibility with life, obtaining a male newborn in whom the thoracic and abdominal defects were verified, and died within a few minutes. IMPLICATIONS FOR PRACTICE: Highlights the importance of structural or morphological ultrasound, between 18 to 24 weeks, to detect major congenital malformations, obtain an accurate diagnosis and timely management. IMPLICATIONS FOR RESEARCH: More studies are required to determine the aetiology and management of these patients, because cases of survival are reported


Assuntos
Humanos , Feminino , Gravidez , Adulto Jovem , Pentalogia de Cantrell/diagnóstico por imagem , Hérnia Diafragmática/complicações , Morte Perinatal/etiologia , Equador/epidemiologia , Ultrassonografia Pré-Natal/métodos , Anormalidades Múltiplas/diagnóstico por imagem
15.
Lancet Child Adolesc Health ; 5(6): 447-458, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33721554

RESUMO

This Review depicts the evolving role of MRI in the diagnosis and prognostication of anomalies of the fetal body, here including head and neck, thorax, abdomen and spine. A review of the current literature on the latest developments in antenatal imaging for diagnosis and prognostication of congenital anomalies is coupled with illustrative cases in true radiological planes with viewable three-dimensional video models that show the potential of post-acquisition reconstruction protocols. We discuss the benefits and limitations of fetal MRI, from anomaly detection, to classification and prognostication, and defines the role of imaging in the decision to proceed to fetal intervention, across the breadth of included conditions. We also consider the current capabilities of ultrasound and explore how MRI and ultrasound can complement each other in the future of fetal imaging.


Assuntos
Anormalidades Congênitas/diagnóstico , Imageamento por Ressonância Magnética/métodos , Cuidado Pré-Natal/estatística & dados numéricos , Diagnóstico Pré-Natal/métodos , Ultrassonografia Pré-Natal/métodos , Cavidade Abdominal/anormalidades , Cavidade Abdominal/diagnóstico por imagem , Cavidade Abdominal/patologia , Tomada de Decisão Clínica/métodos , Anormalidades Congênitas/epidemiologia , Anormalidades Congênitas/patologia , Feminino , Idade Gestacional , Neoplasias de Cabeça e Pescoço/congênito , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Imageamento Tridimensional/métodos , Lactente , Recém-Nascido , Imageamento por Ressonância Magnética/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/tendências , Diagnóstico Pré-Natal/estatística & dados numéricos , Prognóstico , Radiologia/métodos , Doenças da Coluna Vertebral/congênito , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/epidemiologia , Doenças da Coluna Vertebral/patologia , Doenças Torácicas/congênito , Doenças Torácicas/diagnóstico , Doenças Torácicas/epidemiologia , Doenças Torácicas/patologia , Ultrassonografia Pré-Natal/estatística & dados numéricos , Doenças Urológicas/congênito , Doenças Urológicas/diagnóstico , Doenças Urológicas/epidemiologia , Doenças Urológicas/patologia , Gravação em Vídeo/instrumentação
16.
Eur J Med Genet ; 64(4): 104189, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33662639

RESUMO

Although the prognosis of CHARGE syndrome can be highly variable from mild until severe, final diagnosis is difficult to establish in utero. The aim of our study is to compare antenatal and postnatal findings in a retrospective cohort of 10 successive patients with a positive CHD7 gene variant in order to identify the specific prenatal features for CHARGE syndrome diagnosis. Fetal ultrasound, follow-up and supplementary investigations are collected and compared to postnatal findings. Congenital heart defect (7/10), choanal atresia (7/10) and tracheoesophageal atresia (4/10) are the most frequent fetal anomalies found. Inner and external ear anomalies appear as the keystone (constant features) for prenatal diagnosis of CHARGE syndrome in fetuses with multiple anomalies and normal microarray karyotype. External ear malformations are identified in all cases by 3D ultrasound when carefully evaluated. MRI and temporal bone CT-Scan are second line useful tools to assess the diagnosis when looking for semicircular canal agenesis, arhinencephaly and/or choanal atresia. Before availability of prenatal exome sequencing in clinical routine, present findings lead to the recommendation that fetuses, with congenital heart defect (mainly septal and conotruncal), cleft lip/palate or unexplained polyhydramnios should carefully be screened for clues suggesting CHARGE syndrome using 2D and 3D ultrasound, MRI and temporal bone CT-Scan. When CHARGE syndrome is suspected with normal molecular karyotype, CHD7 gene sequencing must be offered.


Assuntos
Síndrome CHARGE/diagnóstico por imagem , Feto/anormalidades , Ultrassonografia Pré-Natal/métodos , Síndrome CHARGE/diagnóstico , Síndrome CHARGE/genética , DNA Helicases/genética , Proteínas de Ligação a DNA/genética , Feminino , Feto/diagnóstico por imagem , Testes Genéticos/métodos , Testes Genéticos/normas , Humanos , Recém-Nascido , Cariotipagem/métodos , Cariotipagem/normas , Imageamento por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética/normas , Masculino , Análise de Sequência de DNA/métodos , Análise de Sequência de DNA/normas , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/normas , Ultrassonografia Pré-Natal/normas
17.
Cochrane Database Syst Rev ; 3: CD012553, 2021 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-33686672

RESUMO

BACKGROUND: There is a need to standardize monitoring in obstetric research of twin pregnancies. Identification of birth weight discordance (BWD), defined as a difference in the birth weights of twins, is a well-documented phenomenon in twin pregnancies. Ultrasound for the diagnosis of BWD informs complex decision making including whether to intervene medically (via laser photo coagulation) or deliver the twins to avoid fetal morbidities or even death. The question is, how accurate is this measurement? OBJECTIVES: To determine the diagnostic accuracy (sensitivity and specificity) of ultrasound estimated fetal weight discordance (EFWD) of 20% and 25% using different estimated biometric ultrasound measurements compared with the actual BWD as the reference standard in twin pregnancies. SEARCH METHODS: The search for this review was performed on 15 March 2019. We searched CENTRAL, MEDLINE (Ovid), Embase (Ovid), seven other databases, conference proceedings, reference lists and contacted experts. There were no language or date restrictions applied to the electronic searches, and no methodological filters to maximize sensitivity. SELECTION CRITERIA: We selected cohort-type studies with delayed verification that evaluated the accuracy of biometric measurements at ultrasound scanning of twin pregnancies that had been proposed for the diagnosis of estimated BWD, compared to BWD measurements after birth as a reference standard. In addition, we only selected studies that considered twin pregnancies and applied a reference standard for EFWD for the target condition of BWD. DATA COLLECTION AND ANALYSIS: We screened all titles generated by electronic database searches. Two review authors independently assessed the abstracts of all potentially relevant studies. We assessed the identified full papers for eligibility, and extracted data to create 2 × 2 tables. Two review authors independently performed quality assessment using the QUADAS-2 tool. We excluded studies that did not report data in sufficient detail to construct 2 × 2 tables, and where this information was not available from the primary investigators. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included 39 eligible studies with a median study sample size of 140. In terms of risk of bias, there were many unclear statements regarding patient selection, index test and use of proper reference standard. Twenty-one studies (53%) were of methodological concern due to flow and timing. In terms of applicability, most studies were of low concern. Ultrasound for diagnosis of BWD in twin pregnancies at 20% cut-off Twenty-two studies provided data for a BWD of 20% and the summary estimate of sensitivity was 0.51 (95% CI 0.42 to 0.60), and the summary estimate of specificity was 0.91 (95% CI 0.89 to 0.93) (8005 twin pregnancies; very low-certainty evidence). Ultrasound for diagnosis of BWD in twin pregnancies at 25% cut-off Eighteen studies provided data using a BWD discordance of 25%. The summary estimate of sensitivity was 0.46 (95% CI 0.26 to 0.66), and the summary estimate of specificity was 0.93 (95% CI 0.89 to 0.96) (6471 twin pregnancies; very low-certainty evidence). Subgroup analyses were possible for both BWD of 20% and 25%. The diagnostic accuracy did not differ substantially between estimation by abdominal circumference and femur length but femur length had a trend towards higher sensitivity and specificity. Subgroup analyses were not possible by sex of twins, chorionicity or gestational age due to insufficient data. AUTHORS' CONCLUSIONS: Very low-certainty evidence suggests that EFWD identified by ultrasound has low sensitivity but good specificity in detecting BWD in twin pregnancies. There is uncertain diagnostic value of EFWD; this review suggests there is insufficient evidence to support this index as the sole measure for clinical decision making to evaluate the prognosis of twins with growth discordance. The diagnostic accuracy of other measures including amniotic fluid index and umbilical artery Doppler resistive indices in combination with ultrasound for clinical intervention requires evaluation. Future well-designed studies could also evaluate the impact of chorionicity, sex and gestational age in the diagnostic accuracy of ultrasound for EFWD.


Assuntos
Peso ao Nascer , Gravidez de Gêmeos , Ultrassonografia Pré-Natal/métodos , Viés , Estudos de Coortes , Feminino , Fêmur/anatomia & histologia , Fêmur/diagnóstico por imagem , Humanos , Gravidez , Padrões de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Circunferência da Cintura
18.
Pediatr Cardiol ; 42(4): 978-980, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33725147

RESUMO

Ruptured diverticula and ventricular aneurysms are rare in the fetus, with a limited number of case reports published previously. Additional fetal complications secondary to these ventricular wall abnormalities can be seen. Interventional measures can be considered and attempted either in utero or postnatally to improve the chance of survival. We present a case of a ruptured diverticulum in a fetus and the clinical course.


Assuntos
Divertículo/diagnóstico , Doenças Fetais/diagnóstico , Ventrículos do Coração/anormalidades , Derrame Pericárdico/diagnóstico , Ultrassonografia Pré-Natal/métodos , Feminino , Feto/diagnóstico por imagem , Aneurisma Cardíaco/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Humanos , Recém-Nascido , Masculino , Derrame Pericárdico/cirurgia , Pericardiocentese/métodos , Gravidez , Cuidado Pré-Natal/métodos , Resultado do Tratamento
19.
J Clin Ultrasound ; 49(4): 307-314, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33665816

RESUMO

OBJECTIVE: To evaluate the clinical value of three-dimensional ultrasound (3D-US) with reformatting technique in the diagnosis of fetal cleft lip/palate (CL/P), especially those involving the secondary palate. METHODS: A total of 113 fetuses suspected with cleft lip (CL) on two-dimensional ultrasound (2D-US) were further evaluated by 2D-US and 3D-US with reformatting technique, in order to clarify the type of oral cleft. Lesions were classified as cleft lip (CL), cleft lip and alveolus (CLA), and cleft lip and palate (CLP) (including primary and secondary palate). All fetuses were followed until birth or termination of pregnancy. The diagnostic accuracies of 2D-US and 3D-US with reformatting technology were compared. RESULTS: Both 2D-US and 3D-US with reformatting successfully detected CLs in the final 103 participants. Among these, 29, 25, and 49 cases were confirmed to have CL, CLA, and CLP, respectively. CL, CLA, and CLP were diagnosed by 2D-US in 34, 66, and 3 cases, respectively, and by 3D-US with reformatting technology in 31, 27, and 45 cases, respectively. The sensitivities of 2D-US and 3D-US with reformatting technology in the diagnosis of CLA were 80% (20/25) and 92.0% (23/25), respectively, and the difference was not statistically significant. For CLP, however, the sensitivities were 6.1% (3/49) and 91.8% (45/49), respectively (P < .001). CONCLUSIONS: Both 2D-US and 3D-US with reformatting technique have high diagnostic accuracy for CL and CLA. However, 3D-US has a much higher diagnostic accuracy for CLP.


Assuntos
Fenda Labial/diagnóstico por imagem , Fissura Palatina/diagnóstico por imagem , Doenças Fetais/diagnóstico por imagem , Feminino , Humanos , Imageamento Tridimensional/métodos , Recém-Nascido , Masculino , Gravidez , Ultrassonografia Pré-Natal/métodos
20.
BMC Pregnancy Childbirth ; 21(1): 188, 2021 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-33676432

RESUMO

BACKGROUND: Prenatal corticosteroid administration is known to be an effective strategy in improving fetal pulmonary maturity. This study aimed to evaluate the impact of maternal betamethasone administration on fetal pulmonary and other arteries Doppler velocity and the correlation between RDS development and Doppler indices results. METHODS: Fifty one singleton pregnancies between 26 and 34 gestational weeks with a diagnosis of preterm labor were included in the exposed group and received betamethasone. Fifty one uncomplicated pregnancies were included in the non-exposed group. Fetal pulmonary, umbilical and middle cerebral arteries Doppler parameters were evaluated before and 24 to 48 h after steroid administration in the exposed group and two times at same intervals in the non-exposed group. Maternal records were matched to neonatal charts if delivery happened, and demographic and outcome data were abstracted. RESULTS: When compared with the nonexposed group, fetuses treated with corticosteroids demonstrated significantly decreased umbilical artery Pulsatility index (PI) and significantly increased the middle cerebral artery PI, pulmonary artery Acceleration time (AT) and pulmonary artery AT/ET (Ejection time), while all other indices remained similar. We found significantly decreased pulmonary artery AT in the fetuses with respiratory distress syndrome (RDS) compared to those that did not. CONCLUSIONS: The results of our study showed that maternal antenatal betamethasone administration caused significant changes in the fetus blood velocity waveforms and also affected the blood flow in the pulmonary artery which led to an increase in the pulmonary artery AT and AT/ET. Among those fetuses with RDS, we found a significant decrease in the pulmonary artery AT, but we did not observe any pulmonary artery AT/ET differences.


Assuntos
Betametasona/administração & dosagem , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Maturidade dos Órgãos Fetais/efeitos dos fármacos , Feto , Síndrome do Desconforto Respiratório do Recém-Nascido , Ultrassonografia Pré-Natal/métodos , Adulto , Feminino , Feto/irrigação sanguínea , Feto/diagnóstico por imagem , Glucocorticoides/administração & dosagem , Humanos , Recém-Nascido , Artéria Cerebral Média/diagnóstico por imagem , Trabalho de Parto Prematuro/diagnóstico , Trabalho de Parto Prematuro/tratamento farmacológico , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Cuidado Pré-Natal/métodos , Artéria Pulmonar/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controle , Ultrassonografia Doppler/métodos , Artérias Umbilicais/diagnóstico por imagem
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